积极采取措施减少与美国医疗保健金融交易相关的行政支出
Nikhil R Sahni1,2, Pranay Gupta2, Michael Peterson2
1Department of Economics, Harvard University, Cambridge, MA 02138, United States.
美国医疗保健行政支出每年超过1万亿美元. 通过自动化和即时支付来改善金融交易生态系统,可以节省400亿至600亿美元,提高付款人和提供者的效率.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健管理部门的管理.
- 卫生信息系统 卫生信息系统
背景情况:
- 美国的医疗保健行政支出相当大,每年接近1万亿美元.
- 医疗保健中的金融交易生态系统每年支出约为2000亿美元.
- 目前的医疗保健金融系统效率低下,交易成本高,索赔和事先授权的处理时间长.
研究的目的:
- 分析美国医疗保健金融交易生态系统的低效率.
- 确定其他行业高效金融交易系统的关键特征.
- 通过促进医疗保健金融交易效率的干预措施估计潜在的成本节约.
主要方法:
- 对医疗保健金融交易成本和处理时间与其他行业的高效模型进行比较分析.
- 对索赔处理和事先授权的当前支出进行评估.
- 从组织和行业层面的干预中建模潜在的成本降低.
主要成果:
- 医疗保健索赔处理成本在每索赔7美元至19美元之间,需要4-6周.
- 预先授权的费用平均为每次提交40-50美元,私人付款者为20-30美元,供应商为20-30美元.
- 通过提高效率,每年可以节省400亿至6000亿美元的潜在成本.
结论:
- 实施立即支付保证和高度自动化可以大大降低医疗保健行政支出.
- 组织层面的干预 (扩展最佳实践) 和行业层面的变化 (集中式清算中心,标准化政策,国家提供商目录) 是至关重要的.
- 优化金融交易生态系统为美国医疗保健系统提供了巨大的节省成本的机会.
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